2024-11-0920221941-874410.1177/194187442110395862-s2.0-85112438305http://dx.doi.org/10.1177/19418744211039586https://hdl.handle.net/20.500.14288/14837Here we report a challenging case of a 52-year-old man presenting with subacute constipation, urinary retention, impotence, absent Achilles reflexes, and hypoesthesia in S2-S5 dermatomes. We review the clinical decision-making as the symptoms evolved and diagnostic testing changed over time. Once the diagnosis is settled, we discuss the sign and symptoms, additional diagnostic tools, treatment options and prognosis.Clinical neurologyJournal Article1941-8752685633600001Q411053